Provider Demographics
NPI:1548571383
Name:GOVANI, SHAHEDA GENE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAHEDA
Middle Name:GENE MARIE
Last Name:GOVANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2051
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54903-2051
Mailing Address - Country:US
Mailing Address - Phone:920-231-1955
Mailing Address - Fax:
Practice Address - Street 1:1819 EVANS ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2361
Practice Address - Country:US
Practice Address - Phone:920-231-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-26
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6521-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist